Insula→Amygdala and Insula→Thalamus Pathways Are Involved in Comorbid Chronic Pain and Depression-Like Behavior in Mice.

The comorbidity of chronic pain and depression poses tremendous challenges for the treatment of either one because they exacerbate each other with unknown mechanisms. As the posterior insular cortex (PIC) integrates multiple somatosensory and emotional information and is implicated in either chronic pain or depression, we hypothesize that the PIC and its projections may contribute to the pathophysiology of comorbid chronic pain and depression. We show that PIC neurons were readily activated by mechanical, thermal, aversive, and stressful and appetitive stimulation in naive and neuropathic pain male mice subjected to spared nerve injury (SNI). Optogenetic activation of PIC neurons induced hyperalgesia and conditioned place aversion in naive mice, whereas inhibition of these neurons led to analgesia, conditioned place preference (CPP), and antidepressant effect in both naive and SNI mice. Combining neuronal tracing, optogenetics, and electrophysiological techniques, we found that the monosynaptic glutamatergic projections from the PIC to the basolateral amygdala (BLA) and the ventromedial nucleus (VM) of the thalamus mimicked PIC neurons in pain modulation in naive mice; in SNI mice, both projections were enhanced accompanied by hyperactivity of PIC, BLA, and VM neurons and inhibition of these projections led to analgesia, CPP, and antidepressant-like effect. The present study suggests that potentiation of the PIC→BLA and PIC→VM projections may be important pathophysiological bases for hyperalgesia and depression-like behavior in neuropathic pain and reversing the potentiation may be a promising therapeutic strategy for comorbid chronic pain and depression.

Unraveling the Complex Web of Fibromyalgia: A Narrative Review.

Fibromyalgia is a complex and often misunderstood chronic pain disorder. It is characterized by widespread musculoskeletal pain, fatigue, and heightened sensitivity, and has evolved in diagnostic criteria and understanding over the years. Initially met with skepticism, fibromyalgia is now recognized as a global health concern affecting millions of people, with a prevalence transcending demographic boundaries. The clinical features and diagnosis of fibromyalgia encompass a range of symptoms beyond pain, including sleep disturbances and cognitive difficulties. This study emphasizes the importance of a comprehensive evaluation for accurate diagnosis, considering the shift from tender point reliance to a more holistic approach. Etiology and pathophysiology involve genetic predisposition, neurotransmitter dysregulation, central sensitization, and immune system involvement. Risk factors such as gender, age, family history, and comorbid conditions contribute to susceptibility. The impact on quality of life is profound, affecting physical and social aspects, often accompanied by mood disorders. Management approaches include pharmacological interventions, non-pharmacological therapies, lifestyle modifications, and alternative treatments. This study also delves into emerging research, exploring advances in neurobiological understanding, brain imaging, genetic markers, glutamate modulation, cannabinoids, gut microbiome, and digital health tools for fibromyalgia management. Overall, this study provides a nuanced and up-to-date overview of the complexities surrounding fibromyalgia, aiming to enhance understanding and support for individuals grappling with this challenging condition.

A holistic biopsychosocial management approach for cis-gender males with chronic pelvic pain syndrome attending sexual health services: a retrospective case review.

OBJECTIVES: Chronic pelvic pain syndrome (CPPS) in men is a condition associated with significant morbidity which is typically managed in sexual health services. We introduced a modified biopsychosocial approach for managing CPPS in men, reducing use of antibiotics and evaluated its application in a retrospective case review. METHODS: Patients attended for a full consultation covering symptomology, onset and social history. Examination included urethral smear and assessment of pelvic floor tension and pain. A focus on pelvic floor relaxation was the mainstay of management with pelvic floor physiotherapy if required. Prescribing of antibiotics being discontinued if no evidence of urethritis at first consultation. The main outcome was change in the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score (which patients completed at each attendance); significant clinical improvement was defined as a NIH-CPSI score reduction of >25% and/or ≥6 points. RESULTS: Among 77 consecutive patients diagnosed with CPPS between April 2017 and December 2018, the mean NIH-CPSI score at the initial visit was 24.1 (11-42). Antibiotics were prescribed to 38/77 (49.4%) and alpha-blockers to 58/77 (75.3%). Overall, 50 (64.9%) patients with a mean initial NIH-CPSI score of 25.4 (11-42) re-attended a CPPS clinic. Among these, the average NIH-CPSI score at the final CPPS clinic appointment declined to 15.9 (0-39) (p<0.001); 34/50 (68%) men experienced significant clinical improvement. Men who attended only one CPPS clinic compared with those who reattended had a shorter duration of symptoms (18 (1-60) vs 36 (1-240) months; p=0.038), a lower initial NIH-CPSI score (21.7 (11-34) vs 25.4 (11-44); p=0.021), but had attended a similar number of clinics prior to referral (2.9 (0-6) vs 3.2 (0-8); p=0.62). CONCLUSIONS: The biopsychosocial approach significantly reduced the NIH-CPSI score in those who re-attended, with 68% of patients having a significant clinical improvement. The first follow-up consultation at 6 weeks is now undertaken by telephone for many patients, if clinically appropriate.

[Baimai Ointment relieves chronic pain induced by chronic compression of dorsal root ganglion in rats by regulating neuroactive ligand-receptor interaction and HIF-1 signaling pathway].

The Baimai Ointment with the effect of relaxing sinew and activating collaterals demonstrates a definite effect on Baimai disease with pain, spasm, stiffness and other symptoms, while the pharmacodynamic characteristics and mechanism of this agent remain unclear. In this study, a rat model of chronic compression of L4 dorsal root ganglion(CCD) was established by lumbar disc herniation, and the efficacy and mechanism of Baimai Ointment in the treatment of CCD were preliminarily explored by behavioral tests, side effect evaluation, network analysis, antagonist and molecular biology verification. The pharmacodynamic experiment indicated that Baimai Ointment significantly improved the pain thresholds(mechanical pain, thermal pain, and cold pain) and gait behavior of CCD model rats without causing tolerance or obvious toxic and side effects. Baimai Ointment inhibited the second-phase nociceptive response of mice in the formalin test, increased the hot plate threshold of normal mice, and down-regulated the expression of inflammatory cytokines in the spinal cord. Network analysis showed that Baimai Ointment had synergistic effect in the treatment of CCD and was related to descending inhibition/facilitation system and neuroinflammation. Furthermore, behavioral tests, Western blot, and immunofluorescence assay revealed that the pain-relieving effect of Baimai Ointment on CCD may be related to the regulation of the interaction between neuroactive ligand and receptors(neuroligands) such as CHRNA7, ADRA2A, and ADRB2, and the down-regulation of the expression of NOS2/pERK/PI3K, the core regulatory element of HIF-1 signaling pathway in spinal microglia. The findings preliminarily reveal the mechanism of relaxing sinew and activating collaterals of Baimai Ointment in the treatment of Baimai disease, providing a reference for the rational drug use and further research of this agent.

Aproximación antropológica al síndrome de dolor miofascial. Una propuesta de intervención / No disponible

Objetivos: - Estudiar el síndrome de dolor miofascial (SDM) desde una perspectiva distinta a la clínica. - Abordar mediante un enfoque interdisciplinar el SDM crónico. - Elaborar una propuesta de intervención sobre el paciente con SDM crónico considerando aspectos antropológicos del dolor. Métodos: Se ha dividido el trabajo en dos partes; una primera en la que se ha realizado una búsqueda de literatura científica relacionada con el objeto de estudio y una segunda en la que, a partir de los resultados obtenidos, se han elaborado las conclusiones a modo de propuesta de intervención. Resultados: Los aspectos antropológicos del SDM no han sido un objeto de estudio habitual por lo que ha sido necesario recurrir a los trabajos sobre el dolor en general: - El dolor va más allá de la experiencia personal y subjetiva del que lo padece, la expresión del mismo y la validación por parte del entorno social responde a factores socioculturales. - El dolor agudo y el dolor crónico tienen unas connotaciones socio-culturales distintas, la literatura científica señala la importancia de encontrar la causalidad para una vivencia más positiva del dolor. - La actitud del terapeuta y la información al paciente son elementos claves en el proceso recuperador. Conclusiones: - Entender el dolor no solo como un hecho natural y subjetivo sino también como una conducta socialmente aprehendida y culturalmente transmitida, influenciada por muchos factores externos. - Necesidad de integrar empatía y "extrañamiento" en el abordaje del paciente con SDM. - Informar al paciente de manera clara y concisa acerca de su proceso de recuperación para convertirle en parte activa del tratamiento. - Necesidad de diseñar líneas de investigación que imbriquen al estudio del SDM con las ciencias sociales en aras a una mayor interdisciplinariedad que redunde en una concepción holística del paciente (AU)

Objectives: - Study the myofascial pain syndrome (MPS) from a different perspective to the clinical one. - Approach chronic MPS by means of an interdisciplinary point of view. - Develop a proposal for intervention in patients with chronic MPS considering anthropological aspects of pain. Methods: Work has been divided into two parts: the first one in which you conduct a search of scientific literature related to the object of study and a second one in which, from the results obtained, conclusions are drawn up to propose intervention. Results: Anthropological aspects of MPS have not been a regular subject of study. Therefore it has been necessary to use studies on pain in general: - Pain goes beyond the personal and subjective experience of those who suffer, the expression, and validation by social environment respond to socio-cultural factors - Acute and chronic pain have a different socio-cultural connotations, scientific literature indicates the importance of finding causality for a more positive experience of pain. - The attitude of the therapist and patient information are key elements in the process of recovery. Conclusions: - Understand the pain not only as a natural and subjective fact but also as a socially learned and culturally transmitted behaviour, influenced by many external factors. - Need to integrate empathy and "estrangement" in addressing the patient with MPS. - Inform the patient clearly and concisely about his recovery process to become an active part of treatment. - Need to develop lines of research so that the study of MPS interacts with social sciences in order to obtain a greater interdisciplinarity which results in a holistic conception of the patient (AU)